Congress Focusing on Opioid Crisis
In response to the deepening opioid crisis, Congress is engaged in a multi-faceted review of a package of opioid bills. The recently passed omnibus bill included an additional $3.6 billion for opioid-addiction and mental-health services such as increased NIH funding, state opioid grant program funding, and law enforcement grant funding. In addition, Congress hopes to move quickly on authorizing legislation with the House projecting a vote before Memorial Day. The various House and Senate committees of jurisdiction are each considering legislation which will presumably be combined into a comprehensive package for consideration.
The House Ways and Means Committee convened several hearings on the issue, specifically looking at ways to protect Medicare beneficiaries from opioid abuse, addiction, and overdoses through evidence-based treatment. The committee recognizes the role that states should play in combating the opioid epidemic as well as the need for additional education about opioids. Ways and Means also sent a request for information (RFI) to the Administration and asked for further stakeholder input.
AMDA-The Society for Post-Acute and Long-Term Care Medicine responded to the stakeholder request with a set of recommendations. We recognized the need to carefully balance the national crisis with the clinical needs of the medically complex and vulnerable patients our members serve. Our submission was based on recent comments the Society made in response to a Center for Medicare & Medicaid Services(CMS) RFI on guidelines in this arena. Our comments referenced recent data published in the Journal of the American Geriatrics Society (JAGS) which states that one in seven residents is on long-acting opioids and the prevalence rate for use of long-term opioids was equivalent or greater than 16%. This is twice as prevalent as the outpatient community at large. The Society letter noted that post-acute and long-term care (PALTC) patients are in a controlled environment where they do not have access to the entire supply of medication, are frail and vulnerable, and hence cannot easily take an excessive quantity—since the medications are administered by professional nursing staff, they are only consumed in accordance with medical orders. For these reasons, we asked that the Committee consider the unique situation facing nursing facility and skilled nursing facility encounters, in a comparable way to hospice and palliative care services, when creating guidelines in this arena. We also urged support for more evidence-based research on management of chronic pain in the elderly population.
The House Energy and Commerce Committee also conducted several hearings, recently finishing two days of hearing on March 23. Energy and Commerce is reviewing about a dozen proposals that would facilitate improved treatment options around new non-addictive pain medications, increase research on opioid abuse, and improve detection and interception of opioids such as fentanyl. Other proposals would promote safe disposal programs, help establish guidelines for the release of patients from hospitals and encourage continuing education in the area.
The Senate Health, Education, Labor, and Pensions Committee convened multiple hearings and is considering a legislative package that would also encourage research into non-addictive painkillers, work to ending the delivery of illicit drugs into the country. Further Food and Drug Administration authority over Fentanyl is also on the agenda. Finally, the committee is hoping to authorize additional funding for state grants to treat opioid addiction. The issues of a specific day limit on initial prescriptions for opioids is also on the agenda.
The Society will continue to monitor the opioid discussion and to educate and advocate on the unique needs of patients in PALTC settings.